Definition

An anal fissure is a split or tear in the lining of the anal canal/rectal opening.

Causes

A fissure most commonly occurs after an episode of constipation or diarrhea.

Symptoms

Symptoms include anal pain, rectal bleeding, swelling, and/or itching. People often describe it as burning or tearing pain with a bowel movement. The pain can be excruciating and may last for minutes or persist for hours after a bowel movement. Bleeding symptoms include seeing small amounts of bright, red blood on the toilet paper or in the toilet water. Lastly, discharge may result as the fissure alternately heals and reopens, causing itching.

Diagnosis & Treatment

Most superficial fissures heal without treatment, but some become chronic and cause ongoing discomfort.

The first step is to correct the constipation or diarrhea and treat any underlying disease. A high-fiber diet or dietary bulk agent with plenty of fluids is recommended. A topical anesthetic ointment may help relieve the pain. Sometimes an ointment is prescribed to relax the spastic muscle and improve blood flow. Spasms may also be relieved by sitting in a warm bath several times a day. These measures usually result in healing; if they do not or the symptoms return, surgery may be required.

Surgery for a fissure (lateral internal sphincterotomy) is typically performed in an outpatient basis in our Surgery Center. The procedure is a brief operation during which a small portion of the sphincter is incised to relieve the spasm and pain and allow the fissure to heal.

Visit the American Society of Colon & Rectal Surgeons website for more information